Endocrinology and Metabolism

Review Article

Mineral, bone & muscle
Complete Blood Count Parameters and Bone Health: Clinical and Experimental Evidence: Jeonghoon Ha, Mayo Ono, Hui Zhu, Caroline Cencer, Xiyu Ge, Joy Y. Wu; Endocrinol Metab. 2025;40(6):811-820. Published online December 3, 2025; DOI: https://doi.org/10.3803/EnM.2025.2695

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Abstract PDF PubReader ePub: Osteoporotic fractures pose a significant burden in aging populations, yet current assessment strategies may overlook systemic factors influencing bone health. Emerging evidence suggests that complete blood count (CBC) parameters, including red blood cell indices, white blood cell (WBC) counts and subtypes, and platelet counts, are associated with skeletal fragility and fracture risk. Anemia has been consistently linked to reduced bone mineral density and increased fracture susceptibility, potentially due to impaired oxygen delivery and osteoblast dysfunction. Elevated red cell distribution width may reflect oxidative stress and has been associated with bone loss. Inflammatory markers such as high WBC count and neutrophil-to-lymphocyte ratio are implicated in enhanced osteoclast activity, while platelet abnormalities may influence bone remodeling and fracture healing. These associations suggest that CBC-derived markers could serve as accessible and cost-effective indicators to support osteoporosis evaluation. However, important limitations remain, including undefined clinical thresholds, limited longitudinal evidence, and uncertain causality. Further research is needed to clarify underlying mechanisms and determine whether correcting hematological abnormalities can improve skeletal outcomes. A cautious, evidence-based approach is warranted to define the role of CBC parameters in the clinical assessment of bone health.

Original Article

Lack of Association between Vitamin D Insufficiency and Cardiovascular or Fracture Risk: A UK Biobank Study: Yongin Cho, Jong Hyun Jhee, Jong Ho Jhee, Hye-Sun Park; Received June 2, 2025 Accepted August 1, 2025 Published online October 15, 2025; DOI: https://doi.org/10.3803/EnM.2025.2482 [Epub ahead of print]

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Abstract PDF Supplementary Material PubReader ePub: Background
Vitamin D deficiency has been linked to increased risks of fractures and cardiovascular (CV) events, but the clinical relevance of the ‘insufficiency’ range remains unclear. We investigated CV and fracture risks across vitamin D levels, with a focus on the insufficiency range.
Methods
Using UK Biobank data, we analyzed 375,044 participants aged 40 to 69 years. Vitamin D status was categorized as deficient (<50 nmol/L), insufficient (≥50 to <75 nmol/L), or sufficient (≥75 nmol/L). Outcomes included three-point major adverse cardiovascular events (3P-MACE; myocardial infarction, stroke, and CV mortality) and major osteoporotic fractures, assessed via hospital records, registries, and death certificates.
Results
The vitamin D-deficient group had an increased risk of CV events (adjusted hazard ratio [aHR], 1.17; 95% confidence interval [CI], 1.11 to 1.24) and fractures (aHR, 1.09; 95% CI, 1.01 to 1.18) compared to the vitamin D-sufficient group. Within the deficient group, the severely deficient group (<30 nmol/L) exhibited a markedly higher risk (aHR, 1.29; 95% CI, 1.21 to 1.37 for 3PMACE; and aHR, 1.20; 95% CI, 1.10 to 1.32 for fractures). In contrast, the vitamin D-insufficient group (50 to 75 nmol/L) showed no significant increase in the risk of either outcome, with no clear benefit or harm observed. Spline curve analysis revealed a negative correlation between vitamin D levels and risk, which was observed only within the deficient range and not within the insufficient range.
Conclusion
Vitamin D deficiency is strongly associated with increased CV disease and fracture risks, whereas the insufficiency range shows no significant risk or benefit, raising questions about its clinical relevance.

Review Articles

Mineral, bone & muscle
From Bone Health to Lifespan: Pleiotropic Effects of Antiresorptive Agents: Kyoung Jin Kim; Endocrinol Metab. 2025;40(4):508-516. Published online August 20, 2025; DOI: https://doi.org/10.3803/EnM.2025.2571

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Abstract PDF PubReader ePub: Osteoporotic fractures are a major contributor to morbidity and excess mortality, particularly among older adults. Antiresorptive agents, including selective estrogen receptor modulators (SERMs), bisphosphonates (BPs), and denosumab, are widely used to prevent fractures, with robust support from clinical evidence. Beyond reducing fracture risk, emerging data indicate that these therapies may provide survival benefits through mechanisms that extend beyond skeletal protection. This review summarizes current evidence on the association between antiresorptive therapy and all-cause mortality, integrating findings from randomized controlled trials and large-scale observational cohorts. Intravenous and nitrogen-containing BPs, as well as denosumab, demonstrate the most consistent mortality reduction, especially in older or post-fracture populations. SERMs may provide modest benefits in selected women with increased cardiovascular or oncologic risk. The observed mortality reduction may be mediated not only by fracture prevention but also by pleiotropic effects, such as vascular protection, immune modulation, metabolic regulation, and anti-cancer actions. These findings underscore the importance of recognizing osteoporosis as a systemic disease and support early, sustained antiresorptive treatment to improve both skeletal and survival outcomes. Further studies are needed to clarify the underlying mechanisms and to guide individualized treatment strategies across diverse patient populations.

Mineral, bone & muscle
Incorporating Artificial Intelligence into Fracture Risk Assessment: Using Clinical Imaging to Predict the Unpredictable: Sung Hye Kong; Endocrinol Metab. 2025;40(4):499-507. Published online August 4, 2025; DOI: https://doi.org/10.3803/EnM.2025.2518

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Artificial intelligence (AI) is increasingly being explored as a complementary tool to traditional fracture risk assessment methods. Conventional approaches, such as bone mineral density measurement and established clinical risk calculators, provide populationlevel stratification but often fail to capture the structural nuances of bone fragility. Recent advances in AI—particularly deep learning techniques applied to imaging—enable opportunistic screening and individualized risk estimation using routinely acquired radiographs and computed tomography (CT) data. These models demonstrate improved discrimination for osteoporotic fracture detection and risk prediction, supporting applications such as time-to-event modeling and short-term prognosis. CT- and radiograph-based models have shown superiority over conventional metrics in diverse cohorts, while innovations like multitask learning and survival plots contribute to enhanced interpretability and patient-centered communication. Nevertheless, challenges related to model generalizability, data bias, and automation bias persist. Successful clinical integration will require rigorous external validation, transparent reporting, and seamless embedding into electronic medical systems. This review summarizes recent advances in AI-driven fracture assessment, critically evaluates their clinical promise, and outlines a roadmap for translation into real-world practice.

Citations

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Quantitative CT Analysis for Predicting Hip Fragility Fracture Risk in Postmenopausal Women: A Value Assessment
昭春杜
Advances in Clinical Medicine.2026; 16(01): 2897. CrossRef
Diagnostic Value of Opportunistic CT-Based Bone Density Assessment in Patients with and Without Sacral Insufficiency Fractures
Julian Ramin Andresen, Guido Schröder, Thomas Haider, Hans-Christof Schober, Reimer Andresen
Diagnostics.2025; 15(22): 2926. CrossRef

Original Articles

Mineral, bone & muscle
Osteoporosis Management after the Occurrence of Medication-Related Osteonecrosis of the Jaw: A 13-Year Experience at a Tertiary Center: Chun Ho Wong, Kimberly Hang Tsoi, Jingya Jane Pu, Nancy Su Jiang, Stacey Sheung Yi Chan, Connie Hong Nin Loong, Xincheng Zou, Carol Ho Yi Fong, Eunice Ka Hong Leung, Alan Chun Hong Lee, Chi Ho Lee, Kathryn Choon Beng Tan, Yu Cho Woo, Yu-xiong Su, David Tak Wai Lui; Endocrinol Metab. 2025;40(6):974-990. Published online June 13, 2025; DOI: https://doi.org/10.3803/EnM.2024.2262

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Background
We investigated osteoporosis management strategies and clinical outcomes following the occurrence of medicationrelated osteonecrosis of the jaw (MRONJ).
Methods
We retrospectively studied individuals diagnosed with MRONJ during osteoporosis treatment who were managed in the Osteoporosis Center or the Oral Maxillofacial Surgery & Dental Unit at Queen Mary Hospital in Hong Kong between 2010 and 2022. We examined subsequent osteoporosis management plans, fracture events, and bone mineral density (BMD).
Results
Thirty-six individuals were included (mean age, 78.5 years; 94.4% women). The estimated prevalence of MRONJ was 0.26%. All patients had been exposed to bisphosphonates, and seven had also received denosumab before MRONJ. Following MRONJ, only 14 individuals continued anti-osteoporosis treatment, a decision influenced by a higher fracture probability at MRONJ onset. The most common regimen was a teriparatide-raloxifene sequence (n=8): three patients achieved stable BMD, four achieved improving BMD, and one exhibited a mixed response. The patient with a mixed BMD response had also been treated with denosumab. Six patients sustained incident fractures after MRONJ, and these patients had lower BMD T-scores than their counterparts. Two patients experienced MRONJ recurrence, which was associated with the resumption of bisphosphonate or denosumab therapy after MRONJ. These patients had higher BMD T-scores than those who did not experience MRONJ recurrence.
Conclusion
MRONJ is challenging because high fracture risk necessitates discontinuation of antiresorptive agents. Teriparatide followed by raloxifene may be a reasonable regimen. Individualised decisions in osteoporosis management after MRONJ are required to balance fracture risk reduction with minimising MRONJ recurrence.

Citations

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Denosumab therapy beyond 10 years: subsequent treatment and densitometric outcomes
Xi Xiong, Chun Ho Wong, Kimberly H. Tsoi, Connie H.N. Loong, Carol H.Y. Fong, Alan C.H. Lee, Chi Ho Lee, Kathryn C.B. Tan, Yu Cho Woo, Manju Chandran, David T.W. Lui
Endocrine Practice.2026;[Epub] CrossRef
Medication-Related Osteonecrosis of the Jaw: An Evidence-Based 2025 Position Statement from a Korean Multidisciplinary Task Force
Jin-Woo Kim, Sung-Hye Kong, Jae-Young Kim, Mi Kyung Kwak, Jun-Young Kim, Ji-Hyeon Oh, Hyung-Youl Park, BeomTaek Kim, Young-Kyun Lee, Jeong Joon Han, Moon-Young Kim, Yong Jun Choi, Yong-Dae Kwon, Kwang-Sup Song, Beom-Jun Kim, Sun-Jong Kim, Seung-Hoon Baek,
Endocrinology and Metabolism.2025; 40(6): 787. CrossRef
Medication-related osteonecrosis of the jaw: an evidence-based 2025 position statement from a Korean multidisciplinary task force
Jin-Woo Kim, Sung-Hye Kong, Jae-Young Kim, Mi Kyung Kwak, Jun-Young Kim, Ji-Hyeon Oh, Hyung-Youl Park, BeomTaek Kim, Young-Kyun Lee, Jeong Joon Han, Moon-Young Kim, Yong Jun Choi, Yong-Dae Kwon, Kwang-Sup Song, Beom-Jun Kim, Sun-Jong Kim, Seung-Hoon Baek,
Journal of the Korean Association of Oral and Maxillofacial Surgeons.2025; 51(6): 333. CrossRef

Mineral, bone & muscle
Synthetic Data-Enhanced Classification of Prevalent Osteoporotic Fractures Using Dual-Energy X-Ray Absorptiometry-Based Geometric and Material Parameters: Luca Quagliato, Jiin Seo, Jiheun Hong, Taeyong Lee, Yoon-Sok Chung; Endocrinol Metab. 2025;40(3):484-497. Published online May 14, 2025; DOI: https://doi.org/10.3803/EnM.2024.2211

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Background
Bone fracture risk assessment for osteoporotic patients is essential for implementing early countermeasures and preventing discomfort and hospitalization. Current methodologies, such as Fracture Risk Assessment Tool (FRAX), provide a risk assessment over a 5- to 10-year period rather than evaluating the bone’s current health status.
Methods
The database was collected by Ajou University Medical Center from 2017 to 2021. It included 9,260 patients, aged 55 to 99, comprising 242 femur fracture (FX) cases and 9,018 non-fracture (NFX) cases. To model the association of the bone’s current health status with prevalent FXs, three prediction algorithms—extreme gradient boosting (XGB), support vector machine, and multilayer perceptron—were trained using two-dimensional dual-energy X-ray absorptiometry (2D-DXA) analysis results and subsequently benchmarked. The XGB classifier, which proved most effective, was then further refined using synthetic data generated by the adaptive synthetic oversampler to balance the FX and NFX classes and enhance boundary sharpness for better classification accuracy.
Results
The XGB model trained on raw data demonstrated good prediction capabilities, with an area under the curve (AUC) of 0.78 and an F1 score of 0.71 on test cases. The inclusion of synthetic data improved classification accuracy in terms of both specificity and sensitivity, resulting in an AUC of 0.99 and an F1 score of 0.98.
Conclusion
The proposed methodology demonstrates that current bone health can be assessed through post-processed results from 2D-DXA analysis. Moreover, it was also shown that synthetic data can help stabilize uneven databases by balancing majority and minority classes, thereby significantly improving classification performance.

Citations

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Artificial Intelligence in Rheumatology: From Algorithms to Clinical Impact in Osteoporosis and Chronic Inflammatory Rheumatic Diseases
Marie Doussiere, Ahlem Aboud, Gilles Dequen, Vincent Goëb
Journal of Clinical Medicine.2026; 15(2): 491. CrossRef

Thyroid Big Data Articles (National Health Insurance Service Database)
Risk of Osteoporotic Fractures among Patients with Thyroid Cancer: A Nationwide Population-Based Cohort Study: Eu Jeong Ku, Won Sang Yoo, Yu Been Hwang, Subin Jang, Jooyoung Lee, Shinje Moon, Eun Kyung Lee, Hwa Young Ahn; Endocrinol Metab. 2025;40(2):225-235. Published online January 15, 2025; DOI: https://doi.org/10.3803/EnM.2024.2101

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Background
The associations between thyroid cancer and skeletal outcomes have not been thoroughly investigated. We aimed to investigate the risk of osteoporotic fractures in patients with thyroid cancer compared to that in a matched control group.
Methods
This retrospective cohort study included 2,514 patients with thyroid cancer and 75,420 matched controls from the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC, 2006–2019). The rates of osteoporotic fractures were analyzed, and associations with the levothyroxine dose were evaluated.
Results
Patients with thyroid cancer had a significantly lower risk of fracture than did the control group (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.69 to 0.94; P=0.006). Patients diagnosed with thyroid cancer after the age of 50 years (older cancer group) had a significantly lower risk of fracture than did those in the control group (HR, 0.72; 95% CI, 0.6 to 0.85; P<0.001), especially those diagnosed with spinal fractures (HR, 0.66; 95% CI, 0.51 to 0.85; P=0.001). Patients in the older cancer group started osteoporosis treatment earlier than did those in the control group (65.5±7.5 years vs. 67.3±7.6 years, P<0.001). Additionally, a lower dose of levothyroxine was associated with a reduced risk of fractures.
Conclusion
In the clinical setting, the risk of fracture in women diagnosed with thyroid cancer after the age of 50 years was lower than that in the control group, which was caused by more proactive osteoporosis treatment in postmenopausal women with thyroid cancer.

Citations

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Increased risk of osteoporosis among thyroid cancer survivors: the influence of postoperative levothyroxine therapy in a nationwide cohort study
Young Bin Cho, Kyoung Sik Park
Annals of Surgical Treatment and Research.2026; 110(2): 84. CrossRef
Assessing the risk of osteoporotic fracture recurrence using CT-based radiomics and machine learning
Xiaoyang Zheng, Caihong Zhu, Rui Zhang, Hongyu Sun
Current Problems in Surgery.2025; 72: 101876. CrossRef
Prospective evidence for the gut–bone axis in osteoporotic fractures: Insights from genetic prediction and metabolite mediators
Binjie Zhu, Xinghao Yu, Huimin Lu, Mingzhu Su, Xiaomin Li, Jianhua Jin, Yongmin Yan, Yi Jin
Bone.2025; 201: 117651. CrossRef

Mineral, Bone & Muscle
Association of Delayed Denosumab Dosing with Increased Risk of Fractures: A Population-Based Retrospective Study: Kyoung Min Kim, Seol A Jang, Nam Ki Hong, Chul Sik Kim, Yumie Rhee, Seok Won Park, Steven R. Cummings, Gi Hyeon Seo; Endocrinol Metab. 2024;39(6):946-955. Published online November 20, 2024; DOI: https://doi.org/10.3803/EnM.2024.2047

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Background
Inhibitory effects of denosumab on bone remodeling are reversible and disappear once treatment is discontinued. Herein, we examined whether and to what extent delayed denosumab administration is also associated with fracture risk using nation-wide data.
Methods
The study cohort included women aged 45 to 89 years who were started on denosumab for osteoporosis between October 2017 and December 2019 using data from the Korean Health Insurance Review and Assessment service. Participants were stratified according to the time of their subsequent denosumab administration from the last denosumab administration, including those with within 30 days early dosing (ED30), within the planned time of 180–210 days (referent), within 30–90 days of delayed dosing (DD90), within 90–180 days of delayed dosing (DD180), and longer than 181 days of delayed dosing (DD181+). The primary outcome was the incidence of all clinical fractures.
Results
A total of 149,199 participants included and 2,323 all clinical fractures (including 1,223 vertebral fractures) occurred. The incidence of all fractures was significantly higher in the DD90 compared to reference group (hazard ratio [HR], 1.2; 95% confidence interval [CI], 1.1 to 1.4). The risk of all fracture was even higher in the longer delayed DD180 group (HR, 1.9; 95% CI, 1.6 to 2.3) and DD181+ group (HR, 1.8; 95% CI, 1.5 to 2.2). Increased risks of fractures with delayed dosing were consistently observed for vertebral fractures.
Conclusion
Delayed denosumab dosing, even by 1 to 3 months, was significantly associated with increased fracture risk. Maintaining the correct dosing schedule should be emphasized when starting denosumab.

Citations

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Medication related osteonecrosis (MRONJ) in the management of CTIBL in breast and prostate cancer patients. Joint report by SIPMO AND SIOMMMS
Francesco Bertoldo, Cristina Eller-Vainicher, Vittorio Fusco, Rodolfo Mauceri, Jessica Pepe, Alberto Bedogni, Andrea Palermo, Umberto Romeo, Giuseppe Guglielmi, Giuseppina Campisi
Journal of Bone Oncology.2025; 50: 100656. CrossRef
Personalizing denosumab therapy in postmenopausal Indian women with osteoporosis: predictive role of bone turnover markers and body mass index in determining dosing interval
Vivek Jha, Sanjay K. Bhadada, Rimesh Pal, Chirag Kharbanda, Sudhaker D. Rao
Osteoporosis International.2025; 36(12): 2531. CrossRef

Mineral, Bone & Muscle Big Data Articles (National Health Insurance Service Database)
Elevated Fracture Risks in Patients Using Inhaled Corticosteroids: A Korean Nationwide Study: Sung Hye Kong, Ae Jeong Jo, Chan Mi Park, Kyun Ik Park, Ji Eun Yun, Jung Hee Kim; Endocrinol Metab. 2025;40(1):82-92. Published online August 30, 2024; DOI: https://doi.org/10.3803/EnM.2024.1990

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Background
In this comprehensive retrospective nationwide cohort study, we examined the relationships between various asthma medications and bone health, utilizing data from the National Health Insurance Service database of South Korea.
Methods
From 2015 to 2019, the relevant dataset included 168,611 individuals aged 66 years, among whom 8,747 were diagnosed with asthma. We focused on a subset of 6,173 patients, all 66-year-old women. Participants were categorized into four groups: nonusers of asthma medication (n=2,868), leukotriene antagonist users (n=2,281), inhaled corticosteroid (ICS) users (n=517), and those using a combination of ICS and long-acting beta-agonist (ICS+LABA) medication (n=507). The primary outcomes measured were the incidences of major osteoporotic fractures and hip fractures during the follow-up period.
Results
Over 2.7 years of follow-up, 615 cases of major osteoporotic fractures and 96 cases of hip fractures were recorded. ICS users exhibited a heightened risk of both injuries, with hazard ratios of 1.38 (95% confidence interval [CI], 1.18 to 1.63; P<0.001) for major osteoporotic fractures and 1.56 (95% CI, 1.33 to 1.83; P<0.001) for hip fractures. Similarly elevated risks were observed in the ICS+LABA group. Notably, the risk associated with ICS was particularly pronounced among patients with osteopenia for both fracture types. Overall, the use of ICS, alone or in combination with LABA, in patients with asthma is associated with significantly increased risks of osteoporotic fractures, especially among those with osteopenia.
Conclusion
These findings underscore the importance of considering bone health when managing asthma, especially in older patients and those with existing bone density issues.

Citations

Citations to this article as recorded by

Osteoporosis Awareness in Asthma Patients Using Inhaled Corticosteroids: A Cross-Sectional Study
Gülcan Öztürk, Berrin Zinnet Eraslan, Serap Diktaş Tahtasakal, Pinar Akpınar, Duygu Silte Karamanlioglu, Feyza Ünlü Özkan, İlknur Aktaş, Sevda Cömert
Sakarya Medical Journal.2025; 15(2): 93. CrossRef
Understanding Glucocorticoid-induced Osteoporosis: Causes, Effects and Management
Mozhdeh Ghamari, Farnoosh Ebrahimzadeh, Kamila Hashemzadeh
Indian Journal of Rheumatology.2025;[Epub] CrossRef

Miscellaneous
Differences in Type 2 Fiber Composition in the Vastus Lateralis and Gluteus Maximus of Patients with Hip Fractures: Jingwen Tian, Minchul Song, Kyu Jeong Cho, Ho Yeop Lee, Sang Hyeon Ju, Jung Ryul Lim, Ha Thi Nga, Thi Linh Nguyen, Ji Sun Moon, Hyo Ju Jang, Jung-Mo Hwang, Hyon-Seung Yi; Endocrinol Metab. 2024;39(3):521-530. Published online June 11, 2024; DOI: https://doi.org/10.3803/EnM.2024.1935

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Background
Aging leads to sarcopenia, which is characterized by reduced muscle mass and strength. Many factors, including altered muscle protein turnover, diminished neuromuscular function, hormonal changes, systemic inflammation, and the structure and composition of muscle fibers, play a crucial role in age-related muscle decline. This study explored differences in muscle fiber types contributing to overall muscle function decline in aging, focusing on individuals with hip fractures from falls.
Methods
A pilot study at Chungnam National University Hospital collected muscle biopsies from hip fracture patients aged 20 to 80 undergoing surgical treatment. Muscle biopsies from the vastus lateralis and gluteus maximus were obtained during hip arthroplasty or internal fixation. Handgrip strength, calf and thigh circumference, and bone mineral density were evaluated in individuals with hip fractures from falls. We analyzed the relationships between each clinical characteristic and muscle fiber type.
Results
In total, 26 participants (mean age 67.9 years, 69.2% male) were included in this study. The prevalence of sarcopenia was 53.8%, and that of femoral and lumbar osteoporosis was 19.2% and 11.5%, respectively. Vastus lateralis analysis revealed an age-related decrease in type IIx fibers, a higher proportion of type IIa fibers in women, and an association between handgrip strength and type IIx fibers in men. The gluteus maximus showed no significant correlations with clinical parameters.
Conclusion
This study identified complex associations between age, sex, handgrip strength, and muscle fiber composition in hip fracture patients, offering insights crucial for targeted interventions combating age-related muscle decline and improving musculoskeletal health.

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Tourniquet Use During Anterior Cruciate Ligament Reconstruction Is Associated With Postoperative Quadriceps Atrophy and Pain but No Negative Effects in the Long Term: A Systematic Review
Caleb V. Hayes, Saad M. Ibrahim, Anna E. Crawford, James R. Jones, Mathew D. Hargreaves, Clay A. Rahaman, Eugene W. Brabston, Thomas B. Evely, Aaron J. Casp, Kevin E. Wilk, Amit M. Momaya
Arthroscopy, Sports Medicine, and Rehabilitation.2025; 7(2): 101040. CrossRef
Volume and quality of the gluteal muscles are associated with early physical function after total hip arthroplasty
Makoto Iwasa, Keisuke Uemura, Mazen Soufi, Yoshito Otake, Tomofumi Kinoshita, Tatsuhiko Kutsuna, Kazuma Takashima, Hidetoshi Hamada, Yoshinobu Sato, Nobuhiko Sugano, Seiji Okada, Masaki Takao
International Journal of Computer Assisted Radiology and Surgery.2025; 20(4): 703. CrossRef

Review Articles

Mineral, Bone & Muscle
Bone Loss after Solid Organ Transplantation: A Review of Organ-Specific Considerations: Kyoung Jin Kim, Jeonghoon Ha, Sang Wan Kim, Jung-Eun Kim, Sihoon Lee, Han Seok Choi, Namki Hong, Sung Hye Kong, Seong Hee Ahn, So Young Park, Ki-Hyun Baek, on Behalf of Metabolic Bone Disease Study Group of Korean Endocrine Society; Endocrinol Metab. 2024;39(2):267-282. Published online April 25, 2024; DOI: https://doi.org/10.3803/EnM.2024.1939

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This review article investigates solid organ transplantation-induced osteoporosis, a critical yet often overlooked issue, emphasizing its significance in post-transplant care. The initial sections provide a comprehensive understanding of the prevalence and multifactorial pathogenesis of transplantation osteoporosis, including factors such as deteriorating post-transplantation health, hormonal changes, and the impact of immunosuppressive medications. Furthermore, the review is dedicated to organ-specific considerations in transplantation osteoporosis, with separate analyses for kidney, liver, heart, and lung transplantations. Each section elucidates the unique challenges and management strategies pertinent to transplantation osteoporosis in relation to each organ type, highlighting the necessity of an organ-specific approach to fully understand the diverse manifestations and implications of transplantation osteoporosis. This review underscores the importance of this topic in transplant medicine, aiming to enhance awareness and knowledge among clinicians and researchers. By comprehensively examining transplantation osteoporosis, this study contributes to the development of improved management and care strategies, ultimately leading to improved patient outcomes in this vulnerable group. This detailed review serves as an essential resource for those involved in the complex multidisciplinary care of transplant recipients.

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John R. Greenland, Michael Perch, Kieran Halloran, Deborah J. Levine, Eric D. Morrell, Anna Reed, Ciara M. Shaver, Jonathan P. Singer, Stuart C. Sweet, Robin Vos, Shambhu Aryal, Nicholas Avdimiretz, Fay Burrows, Daniel Calabrese, Fiorella Calabrese, Silvi
The Journal of Heart and Lung Transplantation.2026; 45(2): e104. CrossRef
The immunobiology and therapeutic potential of regulatory T cells in autoimmune diseases and allergic diseases
Wen-Wen Xie, Jian-Bin Huang, Yi-Chi Zhou, Jing-Yi Yuan, Jia-Xue Feng, Xiao-Hang Shi, Li Tian, Xian-Hai Zeng, Shu-Qi Qiu, Mei-Zhen Zhao, Bao-Hui Cheng, Hao-Tao Zeng
Frontiers in Immunology.2026;[Epub] CrossRef
Osteoporosis After Menopause and After Drug Therapy: The Molecular Mechanism of Bone Loss and Its Treatment
Kelly I-Rong Lee, Jie-Hong Chen, Kuo-Hu Chen
International Journal of Molecular Sciences.2026; 27(2): 641. CrossRef
Bone Health in Young Lung Transplant Recipients: A Retrospective Study
Aviva Lerman, Osnat Shtraichman, Yaron Rudman, Mordechai R. Kramer, Idit Dotan, Gloria Tsvetov, Talia Diker Cohen
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Romosozumab as Treatment for Severe Osteoporosis in Heart and Lung Transplant Recipients
Lisa M. Raven, Jacqueline R. Center, Christopher A. Muir
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Filippo Gabrielli, Elisa Bernasconi, Arianna Toscano, Alessandra Avossa, Alessia Cavicchioli, Pietro Andreone, Stefano Gitto
Pharmaceuticals.2025; 18(3): 342. CrossRef
Exploiting regulatory T cells (Tregs): Cutting-edge therapy for autoimmune diseases
Marwa Hassan, Mohamed Elzallat, Dina Mostafa Mohammed, Mahmoud Balata, Walaa H. El-Maadawy
International Immunopharmacology.2025; 155: 114624. CrossRef
Results of the implementation of a multidisciplinary care protocol for preventing fragility fractures following liver transplantation
A. Monegal, J. L. Carrasco, P. Peris, B. Frade-Sosa, A. Azuaga, H. Florez, A. Dura, N. Guañabens, J. Colmenero
Osteoporosis International.2025; 36(7): 1213. CrossRef
Treatment of osteoporosis in the solid organ transplant recipient: an organ-based approach
Soumya Kurnool, Nandi Shah, Preethika Ekanayake
Therapeutic Advances in Endocrinology and Metabolism.2025;[Epub] CrossRef
Global and regional prevalence of osteoporosis in kidney transplant recipients: a systematic review and meta-analysis
Mobin Ghazaiean, Tahoora Mousavi, Mahmood Moosazadeh
Clinical and Experimental Medicine.2025;[Epub] CrossRef
Endocrine effects of long-term calcineurin inhibitor use in solid organ transplant recipients
Talia Diker Cohen, Idit Dotan, Bronya Calvarysky, Eyal Robenshtok
European Journal of Endocrinology.2025; 193(3): R1. CrossRef
Bone disease in kidney transplant: don’t forget about osteomalacia: a case report and literature review
Francesco Aguanno, Alessia Passaseo, Simona Barbuto, Daniele Vetrano, Guido Zavatta, Guido Marzocchi, Sandro Giannini, Giorgia Comai, Gaetano La Manna, Giuseppe Cianciolo
International Urology and Nephrology.2025;[Epub] CrossRef

Mineral, Bone & Muscle
Acromegaly and Bone: An Update: Andrea Giustina; Endocrinol Metab. 2023;38(6):655-666. Published online December 22, 2023; DOI: https://doi.org/10.3803/EnM.2023.601

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Since our discovery in 2006 that acromegaly is associated with an increased risk of vertebral fractures, many authors have confirmed this finding in both cross-sectional and prospective studies. Due to the high epidemiological and clinical impact of this newly discovered comorbidity of acromegaly, this topic has progressively become more important and prominent over the years, and the pertinent literature has been enriched by new findings on the pathophysiology and treatment. The aim of this narrative review was to discuss these novel findings, integrating them with the seminal observations, in order to give the reader an updated view of how the field of acromegaly and bone is developing, from strong clinical observations to a mechanistic understanding and possible prevention and treatment.

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Integrative Machine Learning Approach for Predicting Resistance to First-generation Receptor Ligands in Acromegaly
Wei Lin, Songchang Shi, Yuanyuan Zheng, Edward Laws, Timothy R Smith, Le Min
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Original Articles

Mineral, Bone & Muscle Big Data Articles (National Health Insurance Service Database)
Association between Smoking Status and the Risk of Hip Fracture in Patients with Type 2 Diabetes: A Nationwide Population-Based Study: Se-Won Lee, Jun-Young Heu, Ju-Yeong Kim, Jinyoung Kim, Kyungdo Han, Hyuk-Sang Kwon; Endocrinol Metab. 2023;38(6):679-689. Published online December 6, 2023; DOI: https://doi.org/10.3803/EnM.2023.1760

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Background
Limited longitudinal evidence exists regarding the potential association between smoking status and hip fracture among individuals with type 2 diabetes. We investigated this association using large-scale, nationwide cohort data for the Korean population.
Methods
This nationwide cohort study included 1,414,635 adults aged 40 and older who received Korean National Health Insurance Service health examinations between 2009 and 2012. Subjects with type 2 diabetes were categorized according to their smoking status, amount smoked (pack-years), number of cigarettes smoked per day, and duration of smoking. The results are presented as hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between smoking status parameters and risk of hip fracture in multivariable Cox proportional hazard regression analysis.
Results
Compared with never-smokers, an increased adjusted HR (aHR) for hip fracture was observed in current smokers (1.681; 95% CI, 1.578 to 1.791), and a comparable aHR for hip fracture was found in former smokers (1.065; 95% CI, 0.999 to 1.136). For former smokers who had smoked 20 pack-years or more, the risk was slightly higher than that for never-smokers (aHR, 1.107; 95% CI, 1.024 to 1.196). The hip fracture risk of female former smokers was similar to that of female current smokers, but the hip fracture risk in male former smokers was similar to that of male never-smokers.
Conclusion
Smoking is associated with an increased risk of hip fracture in patients with type 2 diabetes. Current smokers with diabetes should be encouraged to quit smoking because the risk of hip fracture is greatly reduced in former smokers.

Citations

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Hip fractures and type 2 diabetes in the elderly: Risk factors analysis of the Nedices cohort
Federico Hawkins Carranza, Cristina Martín-Arriscado Arroba, Arturo Corbatón-Anchuelo, Guillermo Martínez Díaz-Guerra, Félix Bermejo Pareja
Diabetes & Metabolism.2025; 51(4): 101656. CrossRef
Bone Health in Type 1 and Type 2 Diabetes: Pathophysiological Mechanisms, Clinical Implications, and Management Strategies
Hermine Carine Pouabe Epse Bodah, Suraiya Rahman Shifa, Sara Saleh, Tuba Abeer Hashmi, Tuleen Al Shawa, Badreshiya Kajal Akshaykumar, Nabeel Sufwan, Rajvinder Kaur, Andrii Shevchuk, Usman Ul Haq, Manju Rai
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Inflammatory impact of cigarette smoking on bone function and structure; a review of evidence
Yashar Shahbaz, Rasoul Shirmohammadi, Shirin Shamsghahfarokhi, Hooman Esfahani, Mobin Forghan, Hojjat Eghbali Jelodar, Leila Ashrafi, Mohammad Mousavi
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Diabetes & Metabolic Syndrome: Clinical Research & Reviews.2024; 18(5): 103044. CrossRef

Mineral, Bone & Muscle Big Data Articles (National Health Insurance Service Database)
Increased Risk of Hip Fracture in Patients with Acromegaly: A Nationwide Cohort Study in Korea: Jiwon Kim, Namki Hong, Jimi Choi, Ju Hyung Moon, Eui Hyun Kim, Eun Jig Lee, Sin Gon Kim, Cheol Ryong Ku; Endocrinol Metab. 2023;38(6):690-700. Published online October 30, 2023; DOI: https://doi.org/10.3803/EnM.2023.1782

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Background
Acromegaly leads to various skeletal complications, and fragility fractures are emerging as a new concern in patients with acromegaly. Therefore, this study investigated the risk of fractures in Korean patients with acromegaly.
Methods
We used the Korean nationwide claims database from 2009 to 2019. A total of 931 patients with acromegaly who had never used an osteoporosis drug before and were treated with surgery alone were selected as study participants, and a 1:29 ratio of 26,999 age- and sex-matched osteoporosis drug-naïve controls without acromegaly were randomly selected from the database.
Results
The mean age was 46.2 years, and 50.0% were male. During a median follow-up of 54.1 months, there was no difference in the risks of all, vertebral, and non-vertebral fractures between the acromegaly and control groups. However, hip fracture risk was significantly higher (hazard ratio [HR], 2.73; 95% confidence interval [CI], 1.32 to 5.65), and non-hip and non-vertebral fractures risk was significantly lower (HR, 0.40; 95% CI, 0.17 to 0.98) in patients with acromegaly than in controls; these results remained robust even after adjustment for socioeconomic status and baseline comorbidities. Age, type 2 diabetes mellitus, cardio-cerebrovascular disease, fracture history, recent use of acid-suppressant medication, psychotropic medication, and opioids were risk factors for all fractures in patients with acromegaly (all P<0.05).
Conclusion
Compared with controls, patients surgically treated for acromegaly had a higher risk of hip fractures. The risk factors for fracture in patients with acromegaly were consistent with widely accepted risk factors in the general population.

Citations

Citations to this article as recorded by

Long-Term Prognosis and Systemic Impact of Acromegaly: Analyses Utilizing Korean National Health Insurance Data
Sangmo Hong, Kyungdo Han, Cheol-Young Park
Endocrinology and Metabolism.2025; 40(1): 1. CrossRef
Musculoskeletal disease in acromegaly—a population-based registry study
Christian Rosendal, Mai Christiansen Arlien-Søborg, Eigil Husted Nielsen, Claus Larsen Feltoft, Åse Krogh Rasmussen, Marianne Skovsager Andersen, Jens Otto Lunde Jørgensen, Jakob Dal
European Journal of Endocrinology.2025; 192(3): 308. CrossRef
Growth Hormone and Bone: Preclinical and Clinical Perspectives
Kevin C.J. Yuen
Endocrine Practice.2025; 31(9): 1197. CrossRef
Bone Health in Acromegaly
Maria Francesca Birtolo, Simona Jaafar, Giacomo Cristofolini, Gherardo Mazziotti, Andrea G. Lania
Endocrinology and Metabolism Clinics of North America.2025; 54(4): 637. CrossRef
Osteoporosis and fragility fractures in patients with acromegaly: A two-center cross-sectional study
Mauricio Alvarez, Juliana Rincon, Maria Mercedes Ulloa, Oswaldo Rincon, Liliana Mejia, Alejandra Alvarado, Andres Pereira, Mónica Bernal
World Journal of Orthopedics.2025;[Epub] CrossRef
Novel approach to bone comorbidity in resistant acromegaly
Stefano Frara, Matteo Acanfora, Vincenzo Franzese, Maria Luisa Brandi, Marco Losa, Andrea Giustina
Pituitary.2024; 27(6): 813. CrossRef

Mineral, Bone & Muscle
Age-Dependent Association of Height Loss with Incident Fracture Risk in Postmenopausal Korean Women: Chaewon Lee, Hye-Sun Park, Yumie Rhee, Namki Hong; Endocrinol Metab. 2023;38(6):669-678. Published online September 1, 2023; DOI: https://doi.org/10.3803/EnM.2023.1734

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Background
Height loss is a simple clinical measure associated with increased fracture risk. However, limited data exists on the association between height loss and fracture risk in postmenopausal Korean women. It is unknown whether this association varies with age.
Methods
Data on height loss over a 6-year period were collected from a community-based longitudinal follow-up cohort (Ansung cohort of the Korean Genome and Epidemiology Study). Incident fractures were defined based on self-reported fractures after excluding those due to severe trauma or toes/fingers. The association between incident fractures and height loss was investigated using a Cox proportional hazards model.
Results
During a median follow-up of 10 years after the second visit, 259/1,806 participants (median age, 64 years) experienced incident fractures. Overall, a 1 standard deviation (SD) decrease in height (1.6 cm/median 5.8 years) was associated with 9% increased risk of fracture (hazard ratio [HR], 1.09; P=0.037), which lost statistical significance after adjustment for covariates. When stratified into age groups (50–59, 60–69, 70 years or older), a 1 SD decrease in height remained a robust predictor of fracture in the 50 to 59 years age group after adjusting for covariates (adjusted hazard ratio [aHR], 1.52; P=0.003), whereas height loss was not an independent predictor of fracture in the 60 to 69 (aHR, 1.06; P=0.333) or the 70 years or older age groups (aHR, 1.05; P=0.700; P for interaction <0.05, for all).
Conclusion
Height loss during the previous 6 years was associated with an increased 10-year fracture risk in postmenopausal women in their 50s.

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Daihun Kang
Archives of Hand and Microsurgery.2025; 30(1): 15. CrossRef
Spine age estimation using deep learning in lateral spine radiographs and DXA VFA to predict incident fracture and mortality
Sang Wouk Cho, Namki Hong, Kyoung Min Kim, Young Han Lee, Chang Oh Kim, Hyeon Chang Kim, Yumie Rhee, Brian H. Chen, William D. Leslie, Steven R. Cummings
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Archives of Osteoporosis.2024;[Epub] CrossRef

Review Articles

Mineral, Bone & Muscle
Skeletal Senescence with Aging and Type 2 Diabetes: Joshua Nicholas Farr; Endocrinol Metab. 2023;38(3):295-301. Published online June 14, 2023; DOI: https://doi.org/10.3803/EnM.2023.1727

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Osteoporosis and type 2 diabetes (T2D) are common diseases that often coexist. While both of these diseases are associated with poor bone quality and increased fracture risk, their pathogenesis of increased fracture risk differs and is multifactorial. Mounting evidence now indicates that key fundamental mechanisms that are central to both aging and energy metabolism exist. Importantly, these mechanisms represent potentially modifiable therapeutic targets for interventions that could prevent or alleviate multiple complications of osteoporosis and T2D, including poor bone quality. One such mechanism that has gained increasing momentum is senescence, which is a cell fate that contributes to multiple chronic diseases. Accumulating evidence has established that numerous boneresident cell types become susceptible to cellular senescence with old age. Recent work also demonstrates that T2D causes the premature accumulation of senescent osteocytes during young adulthood, at least in mice, although it remains to be seen which other bone-resident cell types become senescent with T2D. Given that therapeutically removing senescent cells can alleviate age-related bone loss and T2D-induced metabolic dysfunction, it will be important in future studies to rigorously test whether interventions that eliminate senescent cells can also alleviate skeletal dysfunction in context of T2D, as it does with aging.

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Deepak Vashishth, Ruban Dhaliwal, Mishaela Rubin
Bone.2025; 190: 117301. CrossRef
An update on bone in diabetes
Ornpicha Laohajaroensombat, Methavee Poochanasri, Parinya Samakkarnthai
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Mineral, Bone & Muscle
Cardiovascular Impact of Calcium and Vitamin D Supplements: A Narrative Review: Fatima Zarzour, Ahmad Didi, Mohammed Almohaya, David Kendler; Endocrinol Metab. 2023;38(1):56-68. Published online February 16, 2023; DOI: https://doi.org/10.3803/EnM.2022.1644

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Calcium and vitamin D play an important role in mineral homeostasis and the maintenance of skeletal health. Calcium and vitamin D supplements have been widely used for fracture prevention in elderly populations. Many trials have studied the effectiveness and cardiovascular safety of calcium and vitamin D supplementation, with disparate results. In this review, we summarize the most important trials and systematic reviews. There is significant heterogeneity in clinical trial design, differences in the nature of trial outcomes (self-reported vs. verified), prior calcium intake, and trial size. Inconsistent results have been reported concerning the effects of calcium and vitamin D supplementation on cardiovascular outcomes. Most current guidelines recommend calcium intake of up to 1,200 mg daily, preferably from the diet, without concern for cardiovascular risk. Recommendations regarding vitamin D supplementation vary widely. There is compelling evidence from well-conducted randomized trials that modest vitamin D supplementation is safe but does not confer cardiovascular benefit or cardiovascular harm.

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Original Article

Mineral, Bone & Muscle
Development of a Spine X-Ray-Based Fracture Prediction Model Using a Deep Learning Algorithm: Sung Hye Kong, Jae-Won Lee, Byeong Uk Bae, Jin Kyeong Sung, Kyu Hwan Jung, Jung Hee Kim, Chan Soo Shin; Endocrinol Metab. 2022;37(4):674-683. Published online August 5, 2022; DOI: https://doi.org/10.3803/EnM.2022.1461

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Background
Since image-based fracture prediction models using deep learning are lacking, we aimed to develop an X-ray-based fracture prediction model using deep learning with longitudinal data.
Methods
This study included 1,595 participants aged 50 to 75 years with at least two lumbosacral radiographs without baseline fractures from 2010 to 2015 at Seoul National University Hospital. Positive and negative cases were defined according to whether vertebral fractures developed during follow-up. The cases were divided into training (n=1,416) and test (n=179) sets. A convolutional neural network (CNN)-based prediction algorithm, DeepSurv, was trained with images and baseline clinical information (age, sex, body mass index, glucocorticoid use, and secondary osteoporosis). The concordance index (C-index) was used to compare performance between DeepSurv and the Fracture Risk Assessment Tool (FRAX) and Cox proportional hazard (CoxPH) models.
Results
Of the total participants, 1,188 (74.4%) were women, and the mean age was 60.5 years. During a mean follow-up period of 40.7 months, vertebral fractures occurred in 7.5% (120/1,595) of participants. In the test set, when DeepSurv learned with images and clinical features, it showed higher performance than FRAX and CoxPH in terms of C-index values (DeepSurv, 0.612; 95% confidence interval [CI], 0.571 to 0.653; FRAX, 0.547; CoxPH, 0.594; 95% CI, 0.552 to 0.555). Notably, the DeepSurv method without clinical features had a higher C-index (0.614; 95% CI, 0.572 to 0.656) than that of FRAX in women.
Conclusion
DeepSurv, a CNN-based prediction algorithm using baseline image and clinical information, outperformed the FRAX and CoxPH models in predicting osteoporotic fracture from spine radiographs in a longitudinal cohort.

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Review Article

Adrenal Gland
Long-Term Outcomes of Congenital Adrenal Hyperplasia: Anna Nordenström, Svetlana Lajic, Henrik Falhammar; Endocrinol Metab. 2022;37(4):587-598. Published online July 8, 2022; DOI: https://doi.org/10.3803/EnM.2022.1528

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A plethora of negative long-term outcomes have been associated with congenital adrenal hyperplasia (CAH). The causes are multiple and involve supra-physiological gluco- and mineralocorticoid replacement, excess adrenal androgens both intrauterine and postnatal, elevated steroid precursor and adrenocorticotropic hormone levels, living with a congenital condition as well as the proximity of the cytochrome P450 family 21 subfamily A member 2 (CYP21A2) gene to other genes. This review aims to discuss the different long-term outcomes of CAH.

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Original Article

Mineral, Bone & Muscle
Effect of Vitamin D Supplementation on Risk of Fractures and Falls According to Dosage and Interval: A Meta-Analysis: Sung Hye Kong, Han Na Jang, Jung Hee Kim, Sang Wan Kim, Chan Soo Shin; Endocrinol Metab. 2022;37(2):344-358. Published online April 25, 2022; DOI: https://doi.org/10.3803/EnM.2021.1374

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Background
Although recent studies comparing various dosages and intervals of vitamin D supplementation have been published, it is yet to be elucidated whether there is an appropriate dose or interval to provide benefit regarding fracture risk. We aimed to assess the published evidence available to date regarding the putative beneficial effects of vitamin D supplements on fractures and falls according to various dosages and intervals.
Methods
We performed a meta-analysis of randomized controlled studies reporting associations between vitamin D supplementation and the risks of fractures and falls in PubMed, EMBASE, and Cochrane library. Studies with supplements of ergocalciferol or calcitriol, those with a number of event ≤10, or those with a follow-up duration of less than 6 months were also excluded.
Results
Thirty-two studies were included in the final analysis. Vitamin D supplementation with daily dose of 800 to 1,000 mg was associated with lower risks of osteoporotic fracture and fall (pooled relative risk [RR], 0.87; 95% confidence interval [CI], 0.78 to 0.97 and RR, 0.91; 95% CI, 0.85 to 0.98), while studies with <800 or >1,000 mg/day did not. Also, among intervals, daily administration of vitamin D was associated with the reduced risk of falls, while intermittent dose was not. Also, patients with vitamin D deficiency showed a significant risk reduction of falls after vitamin D supplementation.
Conclusion
Daily vitamin D dose of 800 to 1,000 IU was the most probable way to reduce the fracture and fall risk. Further studies designed with various regimens and targeted vitamin D levels are required to elucidate the benefits of vitamin D supplements.

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Review Article

Mineral, Bone & Muscle
Discontinuing Denosumab: Can It Be Done Safely? A Review of the Literature: Wei Lin Tay, Donovan Tay; Endocrinol Metab. 2022;37(2):183-194. Published online April 14, 2022; DOI: https://doi.org/10.3803/EnM.2021.1369

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Denosumab, which has been approved for the treatment of osteoporosis since 2010, is a fully humanised monoclonal antibody against a cytokine, receptor activator of nuclear factor kappa B ligand (RANKL), involved in bone resorption. Continued use of denosumab results in a potent and sustained decrease in bone turnover, an increase in bone mineral density (BMD), and a reduction in vertebral and hip fractures. The anti-resorptive effects of denosumab are reversible upon cessation, and this reversal is accompanied by a transient marked increase in bone turnover that is associated with bone loss, and of concern, an increased risk of multiple vertebral fractures. In this review, we outline the effects of denosumab withdrawal on bone turnover markers, BMD, histomorphometry, and fracture risk. We provide an update on recent clinical trials that sought to answer how clinicians can transition away from denosumab safely with follow-on therapy to mitigate bone loss and summarise the recommendations of various international guidelines.

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Original Articles

Mineral, Bone & Muscle Big Data Articles (National Health Insurance Service Database)
Hip Fracture Risk According to Diabetic Kidney Disease Phenotype in a Korean Population: Seung Eun Lee, Juhwan Yoo, Kyoung-Ah Kim, Kyungdo Han, Han Seok Choi; Endocrinol Metab. 2022;37(1):148-158. Published online February 28, 2022; DOI: https://doi.org/10.3803/EnM.2021.1315

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Background
Diabetic kidney disease (DKD) is associated with an elevated risk of fractures. However, little is known about the association between proteinuric or non-proteinuric DKD and the risk of hip fracture. Thus, we investigated the incidence of hip fractures among Korean adults with type 2 diabetes mellitus (T2DM) stratified by DKD phenotype.
Methods
In this retrospective cohort study using the Korean National Health Insurance Service database, patients with T2DM who received at least one general health checkup between 2009 and 2012 were followed until the date of hip fracture, death, or December 31, 2018. We classified the DKD phenotype by proteinuria and estimated glomerular filtration rate (eGFR), as follows: no DKD (PU⁻GFR⁻), proteinuric DKD with normal eGFR (PU⁺GFR⁻), non-proteinuric DKD with reduced eGFR (PU⁻GFR⁺), and proteinuric DKD with reduced eGFR (PU⁺GFR⁺)
Results
The cumulative incidence of hip fractures was highest in the PU⁺GFR⁺ group, followed by the PU⁻GFR⁺ group and the PU⁺GFR⁻ group. After adjustment for confounding factors, the hazard ratio (HR) for hip fracture was still highest in the PU⁺GFR⁺ group. However, the PU⁺GFR⁻ group had a higher HR for hip fracture than the PU⁻GFR⁺ group (PU⁺GFR⁺ : HR, 1.69; 95% confidence interval [CI], 1.57 to 1.81; PU⁺GFR⁻ : HR, 1.37; 95% CI, 1.30 to 1.46; PU⁻GFR⁺ : HR, 1.20; 95% CI, 1.16 to 1.24 using the PU⁻GFR⁻ group as the reference category).
Conclusion
The present study demonstrated that DKD was significantly associated with a higher risk of hip fracture, with proteinuria as a major determinant.

Citations

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Nandong Hu, Yiping Zhang, Zicheng Wei, Rui Yu, Yingying Zhang, Xiao Chen
Diabetes, Metabolic Syndrome and Obesity.2025; Volume 18: 1915. CrossRef
Risk of fracture with sodium-glucose cotransporter-2 inhibitors in patients with type 2 diabetes: an updated meta-analysis of randomized controlled trials
Mahdieh Khoshzaban Banisi
International Journal of Physiology, Pathophysiology and Pharmacology.2025; 17(3): 61. CrossRef
Bone Mineral Density and the Risk of Fracture According to eGFR in Postmenopausal Women
Minsang Kim, Kyungdo Han, Jin Kyung Kwon, Jae-ik Oh, Jinsun Lee, Jung Hun Koh, Min Woo Kang, Jeong Min Cho, Semin Cho, Seong Geun Kim, Sehyun Jung, Hyuk Huh, Soojin Lee, Eunjeong Kang, Yaerim Kim, Kwon Wook Joo, Dong Ki Kim, Sehoon Park
Journal of the American Society of Nephrology.2025;[Epub] CrossRef
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Akira Okada, Akira Honda, Hideaki Watanabe, Yusuke Sasabuchi, Shotaro Aso, Kayo Ikeda Kurakawa, Masaomi Nangaku, Toshimasa Yamauchi, Hideo Yasunaga, Hirotaka Chikuda, Takashi Kadowaki, Satoko Yamaguchi
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Fracture risks associated with sodium-glucose cotransporter-2 inhibitors in type 2 diabetes patients across eGFR and albuminuria categories: A population-based study in Hong Kong
David Tak Wai Lui, Tingting Wu, Eric Ho Man Tang, Ivan Chi Ho Au, Chi Ho Lee, Yu Cho Woo, Kathryn Choon Beng Tan, Carlos King Ho Wong
Diabetes Research and Clinical Practice.2023; 197: 110576. CrossRef
Diagnose und Management der Osteoporose bei Diabetes mellitus (Update 2023)
Christian Muschitz, Alexandra Kautzky-Willer, Yvonne Winhofer, Martina Rauner, Judith Haschka, Daniel Cejka, Robert Wakolbinger-Habel, Peter Pietschmann
Wiener klinische Wochenschrift.2023; 135(S1): 207. CrossRef
Association between exercise and risk of fractures in new-onset type 2 diabetes: a retrospective cohort study
Seung Eun Lee, Juhwan Yoo, Bong-Seong Kim, Kyoung-Ah Kim, Kyungdo Han, Han Seok Choi
Archives of Osteoporosis.2023;[Epub] CrossRef
Two-Year Changes in Diabetic Kidney Disease Phenotype and the Risk of Heart Failure: A Nationwide Population-Based Study in Korea
Seung Eun Lee, Juhwan Yoo, Han Seok Choi, Kyungdo Han, Kyoung-Ah Kim
Diabetes & Metabolism Journal.2023; 47(4): 523. CrossRef

Mineral, Bone & Muscle Big Data Articles (National Health Insurance Service Database)
10-Year Fracture Risk in Postmenopausal Women with Osteopenia and Osteoporosis in South Korea: Yeon-Hee Baek, Sun Wook Cho, Han Eol Jeong, Ju Hwan Kim, Yunji Hwang, Jeffrey L. Lange, Ju-Young Shin; Endocrinol Metab. 2021;36(6):1178-1188. Published online December 16, 2021; DOI: https://doi.org/10.3803/EnM.2021.1215

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Background
In South Korea, women aged 66 years are eligible for complimentary bone mineral density (BMD) screening via the National Screening Program for Transitional Ages. We aimed to evaluate the 10-year fracture risk in women receiving BMD screening between January 2008 and December 2015.
Methods
BMD was classified as normal (T-score ≥–1.0 standard deviation [SD]), osteopenia (T-score <–1.0 SD and >–2.5 SD), and osteoporosis (T score ≤–2.5 SD) from dual-energy X-ray absorptiometry. Follow-up continued from the screening date until a diagnosis for clinical fragility fracture (including sites of the vertebrae, hip, pelvis, clavicle, humerus, forearm, wrist, lower leg, and ankle), censored at the earliest date of trauma, death, or December 2017; fracture was ascertained using diagnostic codes from the National Health Insurance Service database. A multivariable Cox proportional hazard model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of fracture in women with osteopenia or osteoporosis relative to women with normal BMD.
Results
Among the 271,197 women screened, 44.0% had osteopenia and 35.2% had osteoporosis. The 10 year cumulative incidence of fragility fractures was 31.1%, 37.5%, and 44.3% in women with normal BMD, osteopenia, and osteoporosis, respectively. Fracture risk was higher in women with osteopenia (HR, 1.31; 95% CI, 1.28 to 1.34) and osteoporosis (HR, 1.68; 95% CI, 1.64 to 1.72) than in women with normal BMD.
Conclusion
Women with osteopenia and women with osteoporosis, identified by the national BMD screening program, demonstrated a substantially elevated risk of fracture.

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Review Article

Mineral, Bone & Muscle
Operationalizing Treat-to-Target for Osteoporosis: E. Michael Lewiecki; Endocrinol Metab. 2021;36(2):270-278. Published online March 24, 2021; DOI: https://doi.org/10.3803/EnM.2021.970

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Treat-to-target (TTT) for osteoporosis is a concept for individualizing patient treatment decisions that focuses on achieving an acceptable level of fracture risk rather than response to treatment alone. While a response to treatment is essential in order to achieve an acceptable level of risk, it is not necessarily sufficient. Some patients have a good response to treatment yet remain at high level of fracture risk. Since there is no way to directly measure bone strength in patients treated for osteoporosis, a surrogate measurement must be used. Bone mineral density (BMD) is commonly used to select patients for treatment and has emerged as the most useful surrogate for assessing reduction of fracture risk after treatment is started. Recent large meta-regression studies have shown a robust correlation between larger increases in BMD with treatment and greater reductions in fracture risk. Application of TTT for osteoporosis involves assessing fracture risk before starting treatment and initiating treatment with an agent that is most likely to reduce fracture risk to an acceptable level, represented by a target BMD T-score, over a reasonable period of time. This review offers suggestions for implementing TTT for osteoporosis in clinical practice and managing patients who fail or succeed in reaching the target. More study is needed to fully validate the use of TTT for osteoporosis for initiating and modifying treatments to reduce fracture risk.

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Original Articles

Clinical Study
Effects of Systemic Glucocorticoid Use on Fracture Risk: A Population-Based Study: Ji Weon Koh, Junkang Kim, Hyemin Cho, Yong-Chan Ha, Tae-Young Kim, Young-Kyun Lee, Ha Young Kim, Sunmee Jang; Endocrinol Metab. 2020;35(3):562-570. Published online September 22, 2020; DOI: https://doi.org/10.3803/EnM.2020.659

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Background
Long-term glucocorticoid use increases fracture risk by reducing bone mass. This study evaluated the relationship between hip and vertebral fractures and the total amount of systematic glucocorticoid use.
Methods
We randomly selected 1,896,159 people aged 20 to 100 years who participated in the National Health Checkup program in 2006. The amount of glucocorticoids prescribed was calculated based on the defined daily dose (DDD). The total DDD was obtained by adding oral and parenteral glucocorticoids for 6 months from the index date. Subjects were categorized into four groups according to total glucocorticoid DDDs: non-users (DDDs=0), low users (0< DDDs ≤45), intermediate users (45< DDDs ≤90), and high users (90< DDDs). We followed them for 2 years. A multivariate Cox proportional hazard model was used to evaluate the effects of the total amount of glucocorticoid use on hip and vertebral fractures.
Results
Higher glucocorticoid use was associated with a higher risk of vertebral fracture. Relative to non-users, the vertebral fracture risk was 1.39 times higher in the low-user group, 1.94 times higher in the intermediate-user group, and 2.43 times higher in the highuser group. The risk of hip fracture was 1.72 times higher in intermediate users and 3.28 times higher in high users than in non-users.
Conclusion
As the amount of glucocorticoid use for 6 months increased, the risk of hip and vertebral fractures became higher. In order to prevent fractures, it is necessary for doctors to evaluate the total amount of glucocorticoid prescribed to the patient and to provide appropriate treatment.

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Journal of Bone and Mineral Metabolism.2026;[Epub] CrossRef
Incidence, prevalence, and predictors of osteoporotic fracture in adult lung transplant recipients
Elisabeth Ng, Shanal Kumar, Eldho Paul, Daniel Bennett, Luisa Rosi, Louise Fuller, Lauren Chiu, Shoshana Sztal-Mazer, Steven Ivulich, Greg Snell, Leon A. Bach, Kathryn L. Hackman
JHLT Open.2025; 7: 100182. CrossRef
Progressive resisted exercise program combined with aerobic exercise on osteoporotic systemic lupus erythematous patients: a prospective randomized controlled trial
Hadaya Mosaad Eladl, Nabil Mahmoud Abdel-Aal, Khadra Mohamed Ali, Doaa Ayoub Elimy, Nesma M. Allam
Disability and Rehabilitation.2025; 47(15): 3887. CrossRef
Risk factors of osteoporotic vertebral fracture cascade and the relationship between blood glucose control and fracture occurrence
Yuyu Fan, Junjie Qiao, Lixiang Ding, Hongxing Song, Yu Hou, Meng Yi, Xiutong Fang
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Evaluating the relationship between bone density, osteoporosis, and some risk factors
Tran Thua Nguyen, Le Thi Ngoc Uyen, Phan Thị Minh Phương, Trần Thị Cẩm Tú, Nguyễn Thị Huệ
Tạp chí Y học lâm sàng Bệnh viện Trung Ương Huế.2025; 17(2): 78. CrossRef
The link between osteoporosis and cardiovascular diseases: a review of shared mechanisms, risk factors, and therapeutic approaches
Mohammad Hasan Sharafi, Afshin Nazari, Mostafa Cheraghi, Faraz Souri, Morteza Bakhshesh
Osteoporosis International.2025; 36(7): 1129. CrossRef
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Feifei Li, Qiujing Chen, Yang Dai, Lin Lu
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Average daily glucocorticoid dose, number of prescription days, and cumulative dose in the initial 90 days of glucocorticoid therapy are associated with subsequent hip and clinical vertebral fracture risk: a retrospective cohort study using a nationwide h
Masayuki Iki, Kenji Fujimori, Shinichi Nakatoh, Junko Tamaki, Shigeyuki Ishii, Nobukazu Okimoto, Hironori Imano, Sumito Ogawa
Osteoporosis International.2024; 35(5): 805. CrossRef
Low-dose glucocorticoid increase the risk of fracture in postmenopausal women with low bone mass: a retrospective cohort study
So Young Park, Seong Hee Ahn, Gi Hwan Bae, Sunmee Jang, Mi Kyung Kwak, Ha Young Kim, Se Hwa Kim
Osteoporosis International.2024; 35(10): 1779. CrossRef
Chronic airway disease as a major risk factor for fractures in osteopenic women: Nationwide cohort study
Sung Hye Kong, Ae Jeong Jo, Chan Mi Park, Kyun Ik Park, Ji Eun Yun, Jung Hee Kim
Frontiers in Endocrinology.2023;[Epub] CrossRef
Bad to the bones: prescribing of drugs for the prevention and treatment of osteoporosis in patients on chronic glucocorticoids
Sarah J. Billups, Vinh K Thai, Jacob Denkins, Ian C. Dettman, Micol S. Rothman
Archives of Osteoporosis.2023;[Epub] CrossRef
High Risk of Fractures Within 7 Years of Diagnosis in Asian Patients With Inflammatory Bowel Diseases
Hyung Jin Ahn, Ye-Jee Kim, Ho-Su Lee, Jin Hwa Park, Sung Wook Hwang, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Beom-Jun Kim, Sang Hyoung Park
Clinical Gastroenterology and Hepatology.2022; 20(5): e1022. CrossRef
Challenges in the diagnosis and management of glucocorticoid‐induced osteoporosis in younger and older adults
Madhuni Herath, Bente Langdahl, Peter R. Ebeling, Frances Milat
Clinical Endocrinology.2022; 96(4): 460. CrossRef
Comparative effectiveness of bisphosphonate treatments for the prevention of re-fracture in glucocorticoid-induced osteoporosis: protocol for a systematic review and meta-analysis
Hongmin Chu, Bo-Hyoung Jang, GaYoon Kim, Seowoo Bae, Hyeju Lee, Seonghee Nam, Jeonghoon Ahn
BMJ Open.2022; 12(9): e062537. CrossRef
Why Do We Need Proactive Management for Fracture Prevention in Long-Term Glucocorticoid Users?
Han Seok Choi
Endocrinology and Metabolism.2020; 35(3): 549. CrossRef

Clinical Study
Low Predictive Value of FRAX Adjusted by Trabecular Bone Score for Osteoporotic Fractures in Korean Women: A Community-Based Cohort Study: Hana Kim, Jung Hee Kim, Min Joo Kim, A Ram Hong, HyungJin Choi, EuJeong Ku, Ji Hyun Lee, Chan Soo Shin, Nam H. Cho; Endocrinol Metab. 2020;35(2):359-366. Published online June 24, 2020; DOI: https://doi.org/10.3803/EnM.2020.35.2.359

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Background
The value of the Fracture Risk Assessment Tool (FRAX) and the trabecular bone score (TBS) for assessing osteoporotic fracture risk has not been fully elucidated in Koreans. We conducted this study to clarify the predictive value of FRAX adjusted by TBS for osteoporotic fractures in Korean women.
Methods
After screening 7,192 eligible subjects from the Ansung cohort, 1,165 women aged 45 to 76 years with available bone mineral density (BMD) and TBS data were enrolled in this study. We assessed their clinical risk factors for osteoporotic fractures and evaluated the predictive value of FRAX with or without BMD and TBS.
Results
During the mean follow-up period of 7.5 years, 99 (8.5%) women suffered major osteoporotic fractures (MOFs) and 28 (2.4%) experienced hip fractures. FRAX without BMD, BMD-adjusted FRAX, and TBS-adjusted FRAX were significantly associated with the risk of MOFs (hazard ratio [HR] per percent increase, 1.08; 95% confidence interval [CI], 1.03 to 1.14; HR, 1.09; 95% CI, 1.03 to 1.15; and HR, 1.07; 95% CI, 1.02 to 1.13, respectively). However, BMD-adjusted FRAX and TBS-adjusted FRAX did not predict MOFs better than FRAX without BMD based on the Harrell’s C statistic. FRAX probabilities showed limited value for predicting hip fractures. The cut-off values of FRAX without BMD, FRAX with BMD, and FRAX with BMD adjusted by TBS for predicting MOFs were 7.2%, 5.0%, and 6.7%, respectively.
Conclusion
FRAX with BMD and TBS adjustment did not show better predictive value for osteoporotic fractures in this study than FRAX without adjustment. Moreover, the cut-off values of FRAX probabilities for treatment might be lower in Korean women than in other countries.

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Update on the utility of trabecular bone score (TBS) in clinical practice for the management of osteoporosis: a systematic review by the Egyptian Academy of Bone and Muscle Health
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Imaging bone turnover assessment through volumetric density-adjusted standardized uptake value using quantitative bone SPECT/CT in osteoporosis
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Sung Hye Kong, Ae Jeong Jo, Chan Mi Park, Kyun Ik Park, Ji Eun Yun, Jung Hee Kim
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Review Articles

Mineral, Bone & Muscle
Potential Biomarkers to Improve the Prediction of Osteoporotic Fractures: Beom-Jun Kim, Seung Hun Lee, Jung-Min Koh; Endocrinol Metab. 2020;35(1):55-63. Published online March 19, 2020; DOI: https://doi.org/10.3803/EnM.2020.35.1.55

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Osteoporotic fracture (OF) is associated with high disability and morbidity rates. The burden of OF may be reduced by early identification of subjects who are vulnerable to fracture. Although the current fracture risk assessment model includes clinical risk factors (CRFs) and bone mineral density (BMD), its overall ability to identify individuals at high risk for fracture remains suboptimal. Efforts have therefore been made to identify potential biomarkers that can predict the risk of OF, independent of or combined with CRFs and BMD. This review highlights the emerging biomarkers of bone metabolism, including sphongosine-1-phosphate, leucine-rich repeat-containing 17, macrophage migration inhibitory factor, sclerostin, receptor activator of nuclear factor-κB ligand, and periostin, and the importance of biomarker risk score, generated by combining these markers, in enhancing the accuracy of fracture prediction.

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Mineral, Bone & Muscle
Skeletal Fragility in Type 2 Diabetes Mellitus: Jakob Starup-Linde, Katrine Hygum, Bente Lomholt Langdahl; Endocrinol Metab. 2018;33(3):339-351. Published online September 18, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.3.339

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Type 2 diabetes (T2D) is associated with an increased risk of fracture, which has been reported in several epidemiological studies. However, bone mineral density in T2D is increased and underestimates the fracture risk. Common risk factors for fracture do not fully explain the increased fracture risk observed in patients with T2D. We propose that the pathogenesis of increased fracture risk in T2D is due to low bone turnover caused by osteocyte dysfunction resulting in bone microcracks and fractures. Increased levels of sclerostin may mediate the low bone turnover and may be a novel marker of increased fracture risk, although further research is needed. An impaired incretin response in T2D may also affect bone turnover. Accumulation of advanced glycosylation endproducts may also impair bone strength. Concerning antidiabetic medication, the glitazones are detrimental to bone health and associated with increased fracture risk, and the sulphonylureas may increase fracture risk by causing hypoglycemia. So far, the results on the effect of other antidiabetics are ambiguous. No specific guideline for the management of bone disease in T2D is available and current evidence on the effects of antiosteoporotic medication in T2D is sparse. The aim of this review is to collate current evidence of the pathogenesis, detection and treatment of diabetic bone disease.

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Namgok Lecture 2017

Adrenal gland
Bone Health in Adrenal Disorders: Beom-Jun Kim, Seung Hun Lee, Jung-Min Koh; Endocrinol Metab. 2018;33(1):1-8. Published online March 21, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.1.1

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Secondary osteoporosis resulting from specific clinical disorders may be potentially reversible, and thus continuous efforts to find and adequately treat the secondary causes of skeletal fragility are critical to ameliorate fracture risk and to avoid unnecessary treatment with anti-osteoporotic drugs. Among the hyperfunctional adrenal masses, Cushing's syndrome, pheochromocytoma, and primary aldosteronism are receiving particularly great attention due to their high morbidity and mortality mainly by increasing cardiovascular risk. Interestingly, there is accumulating experimental and clinical evidence that adrenal hormones may have direct detrimental effects on bone metabolism as well. Thus, the present review discusses the possibility of adrenal disorders, especially focusing on pheochromocytoma and primary aldosteronism, as secondary causes of osteoporosis.

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Original Article

Clinical Study
Osteoporosis and Prevalent Fractures among Adult Filipino Men Screened for Bone Mineral Density in a Tertiary Hospital: Erick S. Mendoza, Amy A. Lopez, Valerie Ann U. Valdez, Leilani B. Mercado-Asis; Endocrinol Metab. 2016;31(3):433-438. Published online August 16, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.3.433

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Background

Osteoporosis in men is markedly underdiagnosed and undertreated despite higher morbidity and mortality associated with fractures. This study aimed to characterize adult Filipino men with osteopenia, osteoporosis and prevalent fractures.

Methods

A cross-sectional study of 184 Filipino men ≥50 years screened for bone mineral density was performed. Age, weight, body mass index (BMI), Osteoporosis Self-Assessment Tool for Asians (OSTA) score, smoking status, family history of fracture, diabetes mellitus, physical inactivity, and T-score were considered.

Results

Of the 184 patients, 40.2% and 29.9% have osteopenia and osteoporosis. Sixteen (21.6%) and 18 (32.1%) osteopenic and osteoporotic men have fragility hip, spine, or forearm fractures. Men aged 50 to 69 years have the same risk of osteoporosis and fractures as those ≥70 years. While hip fractures are higher in osteoporotic men, vertebral fractures are increased in both osteopenic and osteoporotic men. Mere osteopenia predicts the presence of prevalent fractures. A high risk OSTA score can predict fracture. A BMI <21 kg/m² (P<0.05) and current smoking are associated with osteoporosis.

Conclusion

A significant fraction of Filipino men with osteopenia and osteoporosis have prevalent fractures. Our data suggest that fractures occur in men <70 years even before osteoporosis sets in. Low BMI, high OSTA score, and smoking are significant risk factors of osteoporosis.

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Review Articles

Mineral, Bone & Muscle
Dual-Energy X-Ray Absorptiometry: Beyond Bone Mineral Density Determination: Yong Jun Choi; Endocrinol Metab. 2016;31(1):25-30. Published online March 16, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.1.25

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Significant improvements in dual-energy X-ray absorptiometry (DXA) concerning quality, image resolution and image acquisition time have allowed the development of various functions. DXA can evaluate bone quality by indirect analysis of micro- and macro-architecture of the bone, which and improve the prediction of fracture risk. DXA can also detect existing fractures, such as vertebral fractures or atypical femur fractures, without additional radiologic imaging and radiation exposure. Moreover, it can assess the metabolic status by the measurement of body composition parameters like muscle mass and visceral fat. Although more studies are required to validate and clinically use these parameters, it is clear that DXA is not just for bone mineral densitometry.

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Mineral, Bone & Muscle
Growth and Age-Related Abnormalities in Cortical Structure and Fracture Risk: Ego Seeman; Endocrinol Metab. 2015;30(4):419-428. Published online December 31, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.4.419

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Vertebral fractures and trabecular bone loss have dominated thinking and research into the pathogenesis and the structural basis of bone fragility during the last 70 years. However, 80% of all fractures are non-vertebral and occur at regions assembled using large amounts of cortical bone; only 20% of fractures are vertebral. Moreover, ~80% of the skeleton is cortical and ~70% of all bone loss is cortical even though trabecular bone is lost more rapidly than cortical bone. Bone is lost because remodelling becomes unbalanced after midlife. Most cortical bone loss occurs by intracortical, not endocortical remodelling. Each remodelling event removes more bone than deposited enlarging existing canals which eventually coalesce eroding and thinning the cortex from 'within.' Thus, there is a need to study the decay of cortical as well as trabecular bone, and to develop drugs that restore the strength of both types of bone. It is now possible to accurately quantify cortical porosity and trabecular decay in vivo. The challenges still to be met are to determine whether measurement of porosity identifies persons at risk for fracture, whether this approach is compliments information obtained using bone densitometry, and whether changes in cortical porosity and other microstructural traits have the sensitivity to serve as surrogates of treatment success or failure.

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Mineral, Bone & Muscle
The Risks and Benefits of Calcium Supplementation: Chan Soo Shin, Kyoung Min Kim; Endocrinol Metab. 2015;30(1):27-34. Published online March 27, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.1.27

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The association between calcium supplementation and adverse cardiovascular events has recently become a topic of debate due to the publication of two epidemiological studies and one meta-analysis of randomized controlled clinical trials. The reports indicate that there is a significant increase in adverse cardiovascular events following supplementation with calcium; however, a number of experts have raised several issues with these reports such as inconsistencies in attempts to reproduce the findings in other populations and questions concerning the validity of the data due to low compliance, biases in case ascertainment, and/or a lack of adjustment. Additionally, the Auckland Calcium Study, the Women's Health Initiative, and many other studies included in the meta-analysis obtained data from calcium-replete subjects and it is not clear whether the same risk profile would be observed in populations with low calcium intakes. Dietary calcium intake varies widely throughout the world and it is especially low in East Asia, although the risk of cardiovascular events is less prominent in this region. Therefore, clarification is necessary regarding the occurrence of adverse cardiovascular events following calcium supplementation and whether this relationship can be generalized to populations with low calcium intakes. Additionally, the skeletal benefits from calcium supplementation are greater in subjects with low calcium intakes and, therefore, the risk-benefit ratio of calcium supplementation is likely to differ based on the dietary calcium intake and risks of osteoporosis and cardiovascular diseases of various populations. Further studies investigating the risk-benefit profiles of calcium supplementation in various populations are required to develop population-specific guidelines for individuals of different genders, ages, ethnicities, and risk profiles around the world.

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Mineral, Bone & Muscle
Update on Denosumab Treatment in Postmenopausal Women with Osteoporosis: Yong-Ki Min; Endocrinol Metab. 2015;30(1):19-26. Published online March 27, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.1.19

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Denosumab, a fully human recombinant monoclonal antibody to the receptor activator of nuclear factor-κB ligand (RANKL), blocks binding of RANKL to the RANK receptor, found on the surface of osteoclasts and osteoclast precursors, resulting in decreased bone resorption. Subcutaneous denosumab administration once every 6 months increases bone mineral density at the lumbar spine, total hip, and/or femoral neck, and reduces markers of bone turnover significantly in postmenopausal women with osteoporosis. Relative to placebo, denosumab treatment reduces the risk of vertebral, nonvertebral, and hip fractures significantly. The benefits of denosumab treatment are generally obvious after the first dose and were continued for up to 8 years of treatment in an extension study. The tolerability profile of denosumab during this extension phase was consistent with that observed during the initial 3-year FREEDOM trial. Postmarketing safety surveillance has not shown any unexpected findings. Ongoing safety surveillance will more fully define the long-term safety of denosumab. The benefits of denosumab would seem to be greater than its risks. Denosumab is an important choice in the treatment of postmenopausal women with osteoporosis at increased risk of fractures, including older patients who have difficulty with oral bisphosphonate intake and patients who are intolerant of, or unresponsive to, other therapies.

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Mineral, Bone & Muscle
Epidemiology of Osteoporosis and Osteoporotic Fractures in South Korea: Young-Kyun Lee, Byung-Ho Yoon, Kyung-Hoi Koo; Endocrinol Metab. 2013;28(2):90-93. Published online June 18, 2013; DOI: https://doi.org/10.3803/EnM.2013.28.2.90

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Several epidemiologic studies suggested that osteoporosis and osteoporotic fractures are not uncommon in South Korea. However, these previous cohort studies had limitations that may have influenced their results and the generalizability of the study conclusions, including small sample sizes, inclusion of only women, enrollment of participants from specific areas, and nonrandom selection of participants. Recently, epidemiologic studies using a nationwide claim register have been performed to overcome these limitations through collaboration between the Korean Society of Bone and Mineral Research and Health Insurance Review Assessments. Our review of the Korean Nationwide-database Osteoporosis Study could be helpful to obtain accurate incidence and prevalence estimations of osteoporosis and osteoporosis-related fractures in Korea.

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Original Articles

The Association between Serum Endogenous Secretory Receptor for Advanced Glycation End Products and Vertebral Fractures in Type 2 Diabetes.: Cheol Ho Lee, Min Kyung Lee, Hyun Jeong Han, Tae Ho Kim, Jae Hyuk Lee, Se Hwa Kim; Endocrinol Metab. 2012;27(4):289-294. Published online December 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.4.289

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Abstract PDF

BACKGROUND
Patients with type 2 diabetes are known to have an increased risk for osteoporotic fractures compared with non-diabetic subjects. We investigated whether the serum endogenous secretory receptor for advanced glycation end products (esRAGE) or pentosidine was associated with prevalent vertebral fractures in patients with type 2 diabetes. METHODS: We enrolled 140 patients with type 2 diabetes mellitus (73 men aged 50 or older and 67 postmenopausal women). Lateral X-ray films of the spine revealed prevalent vertebral fractures. The serum concentration of esRAGE and pentosidine were measured. RESULTS: The mean age of all patients was 66.2 +/- 6.5 years and 22% of patients had prevalent vertebral fractures. Serum pentosidine levels were similar between those with and without vertebral fractures. There were no significant correlations between serum esRAGE levels and age, body mass index, duration of diabetes, and hemoglobin A1c. However, patients with moderate or severe vertebral fractures have a lower esRAGE level compared to those without after adjusting for age and gender (0.33 +/- 0.12 ng/mL vs. 0.24 +/- 0.03 ng/mL, P < 0.05). Logistic regression analysis demonstrated that patients in the lowest tertile of esRAGE had a higher risk of moderate or severe vertebral fractures (odds ratio, 16.6; 95% confidence interval, 1.4-198.5) than patients in the highest tertile. CONCLUSION: These results revealed that a low esRAGE level was independently associated with moderate or severe vertebral fractures in type 2 diabetic patients.

Citations

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Letter: The Association between Serum Endogenous Secretory Receptor for Advanced Glycation End Products and Vertebral Fractures in Type 2 Diabetes (Endocrinol Metab 2012;27:289-94, Cheol Ho Lee et al.)
You-Cheol Hwang
Endocrinology and Metabolism.2013; 28(1): 76. CrossRef

Association of Coronary Artery Disease and Osteoporotic Vertebral Fracture in Korean Men and Women.: Sun Ok Song, Kyung Won Park, Seung Hoon Yoo, Won Jun Koh, Byung Soo Kang, Tae Ho Kim, Hyeong Jin Kim, Yun Hyeong Cho, Deok Kyu Cho, Se Hwa Kim; Endocrinol Metab. 2012;27(1):39-44. Published online March 1, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.1.39

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Abstract PDF

BACKGROUND
The association of osteoporotic vertebral fracture or osteoporosis with coronary artery disease (CAD) was investigated in Korean men and women. METHODS: Four hundred consecutive postmenopausal women and men aged 50 years and older, undergoing coronary angiography, were enrolled for the evaluation of established or suspected coronary artery disease. CAD was diagnosed if there was narrowing of > 50% diameter in one or more major coronary artery. Morphometric vertebral fracture was assessed using lateral thoracic and lumbar spine radiographs. Bone mineral density was performed using dual-energy x-ray absorptiometry. RESULTS: Of the 400 subjects in the study (mean age of 61.9 +/- 11.6 years), 256 patients had CAD. Vertebral fracture was observed in 94 (23.5%) patients. There was no difference in vertebral fracture according to the presence or absence of CAD. In logistic regression analysis, vertebral fracture was not significantly associated with CAD after adjustment for multiple risk factors. Although women had lower BMD at any given site than men, BMD was not associated with the presence or absence of CAD among 191 patients. CONCLUSION: Our study demonstrated that osteoporotic vertebral fracture or osteoporosis was not associated with coronary artery disease in Korean men and women.

Citations

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Associations of subclinical manifestations of coronary and carotid artery atherosclerosis with bone strength parameters in asymptomatic women
Irina A. Skripnikova, Maria A. Kolchina, Olga V. Kosmatova, Olesia Yu. Isaykina, Vladimir A. Vygodin, Oxana M. Drapkina
Archives of Osteoporosis.2025;[Epub] CrossRef
Fundamental and practical aspects of coronary artery calcification
O. L. Barbarash, V. V. Kashtalap, I. A. Shibanova, A. N. Kokov
Russian Journal of Cardiology.2020; 25: 4005. CrossRef
Assessment of Subclinical Manifestations of Atherosclerosis of Coronary and Peripheral Arteries and Bone Strength Parameters in Women
I. A. Skripnikova, M. A. Kolchina, O. V. Kosmatova, M. A. Myagkova, V. E. Novikov, O. Yu. Isaykina, O. M. Drapkina
Rational Pharmacotherapy in Cardiology.2020; 16(6): 868. CrossRef
Association factor analysis between osteoporosis with cerebral artery disease
Eun-Sun Jin, Je Hoon Jeong, Bora Lee, Soo Bin Im
Medicine.2017; 96(9): e6164. CrossRef
VASCULAR CALCIFICATION, ATHEROSCLEROSIS AND BONE LOSS (OSTEOPOROSIS): NEW PATHOPHYSIOLOGICAL MECHANISMS AND FUTURE PERSPECTIVES FOR PHARMACOLOGICAL THERAPY
A. Dolzhenko, T. Richter, S. Sagalovsky
Almanac of Clinical Medicine.2016; 44(4): 513. CrossRef
Aortic Calcification and Bone Metabolism: The Relationship between Aortic Calcification, BMD, Vertebral Fracture, 25-Hydroxyvitamin D, and Osteocalcin
Kwang Joon Kim, Kyoung Min Kim, Kyeong Hye Park, Han Seok Choi, Yumie Rhee, Yong Ho Lee, Bong Soo Cha, Myong Jin Kim, Sun Min Oh, J. Keenan Brown, Sung Kil Lim
Calcified Tissue International.2012; 91(6): 370. CrossRef

Case Report

Pregnancy-induced Osteoporosis Combined with Multiple Compression Fractures: A Case Report.: Ji Eun Lee, Jin Sun Jang, Sun Hee Ko, Min Hee Kim, Dong Jun Lim, Moo Il Kang, Bong Yun Cha, Sook Hee Hong, Ja seong Bae, Kyeoung Sik Ryu; Endocrinol Metab. 2011;26(2):150-154. Published online June 1, 2011; DOI: https://doi.org/10.3803/EnM.2011.26.2.150

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Abstract PDF

Pregnancy associated osteoporosis (PAO) is a rare condition. It may affect women during pregnancy or after the delivery and it can induce severe back pain. Physicians can find multiple compression fractures on the plain images of these patients. However, little is known about PAO, including the prevalence, the cause, the risk factors and the prognosis. Herein we report on a case of PAO in a 38-year-old female who suffered from severe back pain induced by multiple vertebral compression fractures. After excluding the possibility of unknown malignancy, the patient underwent vertebroplasty to improve the clinical symptom. The bone biopsy results confirmed multiple benign acute compression fractures. The patient was treated with oral bisphosphonate, calcium and vitamin D. She showed clinical improvement without developing any additional vertebral fracture. When young women during pregnancy or just after the delivery complain of persistent back pain, PAO should be considered in the differential diagnosis, and early recognition and treatment are needed for PAO.

Citations

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Effect of teriparatide on pregnancy and lactation-associated osteoporosis with multiple vertebral fractures
Eun Yeong Choe, Je Eun Song, Kyeong Hye Park, Hannah Seok, Eun Jig Lee, Sung-Kil Lim, Yumie Rhee
Journal of Bone and Mineral Metabolism.2012; 30(5): 596. CrossRef

Original Article

Effect of Intermittent Etidronate Therapy on the Prevention of Bone Loss after Kidney Transplantation.: Hye Soo Kim, Jong Min Lee, Sung Kwon Kim, Cheol Whee Park, Chul Woo Yang, Moo Il Kang, Suk Young Kim, Sung Koo Kang, Byung Kee Bang; J Korean Endocr Soc. 2001;16(4-5):426-437. Published online October 1, 2001

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Abstract PDF: BACKGROUND
Osteopenia or osteoporosis is one of the most frequently encountered complications in patients receiving various immunosuppressants after kidney transplantation. The few available preventive strategies for these complications tend to result in various outcomes. In this study, we evaluated the effect of intermittent etidronate therapy for the prevention of bone loss after kidney transplantation. METHODS: Fifty patients who received kidney transplantation for various reasons were recruited and followed for one year. Thirty-eight of these patients commenced etidronate treatment 7 days after operation, the other 12 were followed without etidronate therapy. The treatment consisted of 400mg of etidronate administered orally for 14 days, then repeated four-times every three months. Blood chemistry, iPTH and aluminium levels were tested periodically in all patients. Also checked were bone mineral density of the lumbar spine(L2-4) and femur at baseline, 6 and 12 months after kidney transplantation, as well as D-L spine lateral x-ray at baseline and 12 months. Serum osteocalcin and urine deoxypyridinoline were measured at baseline, 7 days and then every 3 months. RESULTS: Both the etidronate-treated and control groups showed significant decreases in bone mineral densities of the lumbar spine, femur neck and total femur at 6 and 12 months after kidney transplantation(p<0.005). Bone loss was significantly lower in the etidronate-treated group than the control at 12 months after kidney transplantation; lumbar spine(-3.54% vs. -9.51%, p<0.0005), femur neck (-5.41% vs. -8.91%, p<0.0005), total femur (-7.59% vs. -9.07%, p<0.005). Osteocalcin was decreased and deoxypyridinoline increased in both groups. No significant differences in the level or pattern of osteocalcin and deoxypyridinoline were observed in either group. New radiologic compression fractures were found in two patients of the treated group who exhibited severe osteoporosis at baseline during follow-up. CONCLUSIONS: The intermittent administration of etidronate seems to be effective in preventing rapid bone loss after kidney transplantation. Furthermore, this method is safe and convenient for administration and follow-up. Further studies will be required to elucidate the most effective treatment course for the prevention of fractures after kidney transplantation, especially in patients with established severe osteoporosis.

Case Report

A Case of Postpregnancy Spinal Osteoporosis.: Ji Young Seo, Hyeon Kyu Kim, Cheol Soo Choi, Doo Man Kim, Sung Hee Lim, Jae Myung Yoo, Moon Gi Choi, Huung Joon Yoo, Sung Woo Park, Jin Young Lee; J Korean Endocr Soc. 2001;16(2):265-270. Published online April 1, 2001

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Abstract PDF: Osteoporosis is a common disease of the elderly and occurs especially in the postmenopausal women. Rarely, it occurs during a pregnancy or shortly thereafter and is accompanied by a substantial bone loss, resulting in fractures. The clinical significance of pregnancy-associated osteoporosis has been noted since the 1950s. Although its etiology is still unknown, it has recently been proposed that PTHrP may be an important causative factor in pregnancy-associated osteoporosis. There are three types of the pregnancy-associated osteoporosis, (1) a transient osteoporosis of the hip pregnancy, (2) a postpregnancy spinal osteoporosis and (3) a lactation-associated osteoporosis. Postpregnancy spinal osteoporosis typically occurs within three months after a first delivery and usually involving the axial skeleton accompanied by back pain, bone loss and a fracture. We present a case of postpregnancy spinal osteoporosis that developed three months after a first delivery. Our patient also showed multiple compression fractures in her lumbar spine and biochemical evidence of increased bone resorption.

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